Meniscus and ACL Injury
Case Study: Leewan Yomen
Case Study: Leewan Yomen
What happened?
Our case study is about a 42-year-old woman who injured her knee
while teaching a tumbling class at a dance studio. This woman is a former
gymnast and is moderately athletic. While demonstrating how to land and
transition into a twisting move, her knee popped. She was not able to put any
pressure on her leg and was in extreme pain. Her leg immediately began to swell
and was sensitive to the touch. She was admitted to the emergency room.
Emergency room Doctors requested x-rays of both lower extremities,
to view any discrepancies. No fractures or breaks were noted. The woman was
prescribed Hydrocodone/acetaminophen and told to take ibuprofen. She was given
a full leg brace to keep the leg stable and crutches to support her weight. She was advised to
see her family Dr. within 24 hours, and she was released.
Her family Dr. was seen the following day. He ordered MRI of the right knee to see the ligaments. The ACL was completely torn, and the Meniscus tear was
visible. The woman was referred to a sports medicine specialist.
The sports medicine specialist scheduled a surgery after a review of her
case. He recommended arthroscopic surgery, due to the torn ACL not healing itself. An arthroscopic surgery is a minimally invasive
surgical procedure that allows most patients to return home several hours after
surgery.
An anterior
cruciate ligament (ACL) injury
The over stretching or tearing of the ACL in the knee. ACL is one of the key ligaments that help stabilize your knee joint. The ACL connects your thigh bone (femur) to your shinbone (tibia). It's most commonly torn during sports that involve sudden stops and/or changes in direction. ACL injuries are one of the most common knee injuries among athletes. According to the American Orthopedic Society for Sports Medicine, about 150,000 ACL injuries occur in the United States every year. Also, according to the American Academy of Orthopedic Surgeons, about 70 percent of ACL injuries in athletes happen through mechanisms such as pivoting, cutting, sidestepping, out of control play or awkward landings, while about 30 percent of ACL injuries occur from contact with other players. This information is taken from Live Strong.
The over stretching or tearing of the ACL in the knee. ACL is one of the key ligaments that help stabilize your knee joint. The ACL connects your thigh bone (femur) to your shinbone (tibia). It's most commonly torn during sports that involve sudden stops and/or changes in direction. ACL injuries are one of the most common knee injuries among athletes. According to the American Orthopedic Society for Sports Medicine, about 150,000 ACL injuries occur in the United States every year. Also, according to the American Academy of Orthopedic Surgeons, about 70 percent of ACL injuries in athletes happen through mechanisms such as pivoting, cutting, sidestepping, out of control play or awkward landings, while about 30 percent of ACL injuries occur from contact with other players. This information is taken from Live Strong.
A meniscus tear injury
This occurs when its structural integrity is compromised and the fibrocartilage that makes up the meniscus tears, breaks, cracks, ruptures, or splits. These injuries are caused by a combination of axial loading and rotational forces that create a shearing force on the meniscus. A meniscus tear usually occurs with an ACL injury.
This occurs when its structural integrity is compromised and the fibrocartilage that makes up the meniscus tears, breaks, cracks, ruptures, or splits. These injuries are caused by a combination of axial loading and rotational forces that create a shearing force on the meniscus. A meniscus tear usually occurs with an ACL injury.
The meniscus are crescent shaped pads of fibrocartilage
between the femoral condyles and tibial plateaus that help with load
distribution, knee stabilization during rotation, and lubrication of the knee
joint, it also helps to absorb shock so our bone surfaces are not damaged. The
medial and lateral menisci attach to their corresponding lateral collateral
ligaments with the medial meniscus attached more rigidly than the lateral meniscus.
Knee meniscal injuries are common with an
incidence of 61 cases per 100,000 persons and a prevalence of 12% to 14%. There is an increased incidence of
meniscal tears with anterior cruciate ligament (ACL) injury ranging from 22% to
86% in the US, of the estimated 850,000 cases
per year, 10% to 20% of orthopedic surgeries involve surgical repair of the
meniscus. This information
is taken from PM&R Knowledge now.
Surgery
Arthroscopy is a type of surgical procedure that surgeons use to
look within a joint and diagnose and treat problems within a joint. Arthroscopy
is done by making a small incision in the skin and sticking a small
pencil-sized instrument with a lighting system and lens. Surgeons look at
what’s inside the joint by using a miniature television camera, which is hooked
up to the arthroscope. Arthroscopy is necessary because the diagnoses that are
made can sometimes be more accurate than X-ray studies or “open” surgery.
Recovering from arthroscopy is much more easy than recovering from “open”
surgery, though arthroscopy still requires use of a general, spinal, or a local
anesthetic, and special
equipment in a hospital operating room. With this procedure the ligament must
be replaced because they could not reattach existing ACL. ACL once torn cannot
regenerate or repair itself. The replacement ligament is harvested from a
corpse or from the person’s own tissue (autograft). Using your own tissue
reduces the chance of your ACL to rupturing again. The thigh or the vastus medialis is the newest place to harvest tissue and has been proven to have
high success rate and less chance of re injure over time.
The vastus medialis muscle is a part of the quadriceps
muscle group, located on the front of the thigh. It is the most medial, or
inner, of the quadriceps muscles. It extends the entire length of the thigh.
The portion of the muscle that is just above the knee is sometimes referred to
as the vastus medialis obliquus, or VMO. This muscle is used to extend the leg
at the knee and to stabilize the patella or kneecap.
Recovery
Five days after surgery
Five days after surgery
The small incision that the instrument (arthroscopy) goes into
skin will take several days to weeks to heal. Patient advice on gaining full
mobility of leg through stretches demonstrated by physical therapist. Massaging
scars will be painful but will lesson scar tissue intrusion of leg mobility.
Scar tissue build up will interfere with gaining full mobility long term.
Patient should visit Physical therapy three times a week for the best results.
Stationary bike and band work to gradually strengthen muscles will be gradually
added as mobility increases. ACL and Meniscus will take a minimum of 3 months
to heal. Full recovered estimated to take one year if the patient continues
with recommended treatment plan.
 |
| 3 month after surgery |
Sources:
North Bay
Healthcare, Robert Peterson, MD
Live Strong
Statistics on ACL Injuries in Athletes
ERIN COLEMAN, R.D., L.D.
PM&R
Knowledge NOW Article on MENISCUS INJURIES OF THE KNEE https://now.aapmr.org/meniscus-injuries-of-the-knee/
